Provider Demographics
NPI:1194179424
Name:DIALLO, FELICIA GENEVA (LVN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:GENEVA
Last Name:DIALLO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 SEASONS RD
Mailing Address - Street 2:APT 1107
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4602
Mailing Address - Country:US
Mailing Address - Phone:972-916-1448
Mailing Address - Fax:
Practice Address - Street 1:2402 SEASONS RD
Practice Address - Street 2:APT 1107
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4602
Practice Address - Country:US
Practice Address - Phone:972-916-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307113305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service